Permit CITY OF TIGARD ELECTRICAL PERMIT
o , COMMUNITY DEVELOPMENT Permit #: ELC2012 -00392
T t G A RD 13125 SW Hail Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
Parcel: 2S104AD06000
Jurisdiction: Tigard
Site address: 12932 SW SEVILLA AVE
Project: Sheldon Subdivision: WALNUT CROSSING Lot: 7
Project Description: (1) branch circuit for heat pump
Contractor: CLAPSHAW ELECTRIC Owner: SHELDON, CHARLOTTE M
1722 17TH AVE 12932 SW SEVILLA AVE
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 357 -4221 PHONE: 503 - 524 -2272
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/28/2012 $56.18
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 06/28/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OAR 952-001-0090. JILL-4,1 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: )(UM / L[ Permittee Signature: a "" APPt/C4714
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
06/27/2012 16:33 5035981960 CE • JAY OF TIGA. I-' it n..
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13123 5w Hell Blvd.. Tigard, OR sins CI OFTKCA .
- Y . Phone: 503.718.2439 Fern: Saga I0 i.-. I }�1��' :.: np Fig - a017,-OD
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inspection Line; 503.6W 4175. i3 a rt - : p01•/1fY / � se. Pope tl
loner errtw.tigard•or.@nov Nos�ronomodwd 1 copplemora rofemrela•
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TYPS OF VA** . - ' ' • - . . : . • • • •: , c , .lirl`r1Li'':fleViE1>r; '
E1 New construction Addldol�mt tiorvrepl ' Mew hra�.A 41$4 owl; (•w�;O a.e,y orih a *Mani ei 0 In t i)..
❑ Demolition ❑Oche,: D Service at AeQa,41)0 wept or mem O a- irditg um Ora aorta.
when ,,, .endr.Ilb huh amem D Krim endtelrafa►.
- CATZGORY OF arcade 10,000 amp a Mutts at 0 Ptealol hetl6aR.
icy, la remit °memdw 14,000 a Copeaemeietrpre.ph+M1"ral
ET l- and 1.funily dwelling Cert11t11ateiauindltStri61 Meossory building awake d, 0dbriwrmtleram. boildiest.
O Multi - family 0 Maser builde ❑ Othe ❑timpoop 0 l"atltrel.o of 75 /Con or
v SITE INFORMA7'It�l Alh) Leven* mY - OFinagro 1 01 lance,
. _ Q Addia.i' row lo wdof 0 A°. 'E","f.Y, '1.3 ".
yob n S a w a te: l 7tg3 Z sw S� 1 A ve . lamer no Mas ocuomer.
QS& or ono rosAt+li.l oat 0 ltaacaana•1 wade fie•
CtglStascIZIP: a a Htalttwin Ammo. D Sepol7 .tlale Ca nem ono
D Hoesede+r louden. 609 PoIn =mini.
SuiteWdp/apt. net.: Project name: < / r O sel•itear toiler 6/1e aux � wan=
-
Crosl 9traUdireerions to jab sits ' t► t os ea, r Try r .
- New radii:send w le- or d wily dwelling oast. ,
lel llmp smelted gouge.
• Subdivision: _ i Lot no.: 1,000sq. a trams 161.54 4
Ea. WI S00 sq. R. or portion 33,92 1
Tax p4trel h0.: - mi.d mom leadeneial
otscau'rroN OF WORK oboe
I 1200 2
— •
rt p any, 7s.aa a
/1!8111 �►tvfT retidentid Nom Move SO, a) ,
9efv iee. er Feeders inetoll■I &undoes, ardfnr rdoeatbo
�, 100 maw or tai 100.70 • 2
D Piwr ot own 1 � 0 maw • sot moo to 402 ant 1111 133 56 1111 2
Name: `401 imps to 600 raps 200.34 2
. 601 .. Io 13100lops 11.1 301 2
Address: over 1 000 empsor vatte `fi 2
1
• City/State/VP: wdeclttina weiniat arftatentasIilaion .ndtsstion . aad/er
Phone; ( ) I Fax: ( ) 700 row nr 1816 so.36 I
Owner installation: This installation is being made on property that I own which is not 101 aatpw to 400 amps 123.01 2
Wended for sale. lease, rent or exrhangc, according to ORS 441, 449. 670, and 701. 4D1 ""p to il9P raps 1011.$4 7
Braadlsisples - erwallerseira, eaenwiea;perissnrl
Owner igoWurc: _ Date: ti Fa for itmdt circuits saw
• 0 APVLZCAI4 r 0 CONTACT FEISO)tf eMMe service or utter f ee, 7A2 1
each Tooth Omit
flintiness name: e. Fen nosh cicala awrii
— 1 no iw sevicewrreaterfee. (km Contact I j • 3611 S6•« a
mmtle: boob eircom
Each add•% %tMnencil»lit 7.42 2
Aridness:
- INIPrdla.egea (Service Cr Resler not inaludcd t:
C /State/ZIP. . • MI oradicauad m mod lar
try *maim service endear *oiler 67.14 2
Ph: ( ) I Fa:: ( ) Aeeonaeareaty
i 07.14 2
Pta
E -mail: ep(440l.rioncird4 67,64 2
Sig" ataMliwl 6 z
- Slane gleoil(e) m mbt iltd atelgy
Business name' , 4 ' - r .ti . I vow dhaa.bk roe r 1 die ahoPa 2
A°- -_12 l7 Ave _ Mellowed inspection 0 hem; )
1 he =t, 666s3t fa •
ladttn,rial plena (I b =in) 70.11lhr
Phone; (s 157- • 4 73 . 1 , Fax: (3'04) 357 -- if 2.1.- l Itvrctlatn fas.mietaap feu a 90 0e, m
fleet listed lir min
11 1)3 0 f 13 Lic.: / /l : EIe .. Lie.: o ( Suprv. Lic.: -,, p ELECTAWAL Maim Pus
Salim Electrician signature. requires '- _ / i to 1, 1. subtotal:
Plan review (2S% of Strobe fa} , to , , W
Print name: , . + Date: � o . Sod. c (12%of pctnmii feel • (,. 7 t� -
Authorized . _ • i ` • , r� +S . TarAL PF,RMIT RAE r. A fa 2
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